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elderly female with history of DMII, high blood pressure and osteoporosis…
elderly female with history of DMII, high blood pressure and osteoporosis comes in with urine in her blood
background
structures and functions
urethra
tube that takes urine from bladder to out of body
ureters
takes urine from kidney to bladder
kidney
filter blood, remove waste products, make urine
urinary bladder
stores the urine
general info
DM II
body either doesn't produce enough insulin or resists insulin
sugar builds up in bloodstream
hypertension (high blood pressure)
force of blood against artery walls is too high
above 140/90
osteoporosis
new bone formation doesn't keep up with the loss of bone
bones are weak and brittle
structures of nephron
renal corpuscle
glomerular capsule
parietal layer
visceral layer
glomerulus
capsular space
tubular pole
vascular pole
afferent arteriole
efferent arteriole
renal tubule
nephron loop
descending limb
ascending limb
DCT
PCT
collecting duct
collecting tubule
substances that are filtrated, reabsorbed and secreted
reabsorbed in PCT: 66% of salt and water, 100% of glucose, 100% of amino acids, 66% potassium, 50% urea, 80% phosphate
also reabsorbed: Na,K,Ca,Mg,Cl,HCO,H2O
reabsorbed in DCT: Na, Cl, HCO, H2O
secreted in PCT: urea,uric acid,creatinine, H, NH4
secreted in loop of henle: urea
secreted in DCT: H, K, NH4
water, glucose, amino acids,ions, urea, some hormones, vitamins B and C, ketones, and very small amounts of proteins are filtered in the glomerulus
upstream
factors from her 3 prior conditions
DM II
sugar builds up in bloodstream and kidneys filter the blood
complications can include kidney damage and heart and blood vessels disease and increases risk of hypertension
hypertension
causes are kidney problems, adrenal gland tumors, thyroid problems, and certain medications
complications include weakened and narrowed blood vessels in your kidneys, heart attack, heart failure
osteoporosis
low calcium intake
could be caused by low calcium intake or low hormone levels like sex hormones, thyroid hormones or from overactive parathyroid or adrenal glands
downstream
effects on kidneys
osteoporosis
when you have this your hormone levels are off and you most likely have hyperparathyroidism. PTH regulates your calcium levels in the body and when you have too much of it it decreases your calcium levels causing the bone making cells to be slower than the bone breaking cells because you need calcium to build bone
because of fluctuating levels of calcium the kidneys are affected
hypertension (high blood pressure)
with high blood pressure the blood pushed against the artery walls which can cause damage and because the kidneys filter the blood so when the blood vessels are damaged the nephrons that filter the blood don't receive the necessary oxygen and nutrients to function well
DM II
by having too much sugar in bloodstream it can cause damage to blood vessel clusters in the kidney that filter waste in blood
this leads to kidney damage and high blood pressure
if nothing changes
kidney damage or even failure
why is there blood in her urine?
what is most likely cause the blood in urine is the fact that she has high blood pressure from DM II which could have damaged the blood vessels in the kidney and caused some blood to leak into the urine